Provider Demographics
NPI:1740756717
Name:RENAUD, ABRAHAM RAY (DC)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:RAY
Last Name:RENAUD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1403
Mailing Address - Country:US
Mailing Address - Phone:573-756-6496
Mailing Address - Fax:
Practice Address - Street 1:1636 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4601
Practice Address - Country:US
Practice Address - Phone:636-536-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017031979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor